Letter: Public must decide how to pay for NHS

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Sir: The letter from Dr Brighouse (18 November) about the rationing now widespread in the NHS and the supposed development of a two-tier system to the disadvantage of patients of non-fundholding GPs does not address the true problem.

In common with a large number of neighbouring fundholding practices we have had to instruct our local hospitals to stop all non-urgent admissions. The reason is clear from the following figures, comparing the number of procedures purchased by our practice of 11,000 patients last financial year and in the first six months of this year.

In-patient procedures

Carried out, 1995-96 180

In budget, 1996-67 251

Carried out, April-Sept 1996 141

Day-case procedures

Carried out, 1995-96 342

In budget, 1996-67 401

Carried out, April-Sept 1996 379

The problem is that the drive to efficiency which the internal market aims to achieve has happened. The hospitals can now process more patients than ever before. Unfortunately there is no money available to pay for all this additional work.

There are only two possible solutions: for the Government, any government, to find realistic additional money to allow the hospitals operate at maximum capacity and reduce waiting lists; or for hospitals to temporarily downsize, or even, heaven forbid, reduce the number of hospitals to fit in with required and affordable capacity.

I see no evidence either locally or nationally of a proper costed debate which allows those most affected, the general public, to decide which of these alternative paths they wish to choose and to pay for.